连续性血液净化在8kg以上儿童重症肾衰竭疗效  

Effect of continuous blood purification therapy in acute severe renal failure children over 8 kg

作　　者：李洪[1] 徐明芝[1] 向伟[2] 陈如满[1] 安娜[1] 王爱民[3] 陈玉雯[2] 卢飞杏[1] 曾丽华[1] 吴红兰[1] 

机构地区：[1]海南省人民医院血液净化中心,海南海口570311 [2]海南省人民医院儿科,海南海口570311 [3]海南省卫生学校,海南海口570311

出　　处：《生物医学工程与临床》2012年第2期132-136,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨连续性血液净化技术(CBP)在急性肾衰竭(ARI)及ARI合并多脏器功能衰竭(MODF)患儿中使用效果。方法回顾性分析海南省人民医院1999年至2010年体质量8 kg以上患儿17例,其中男性14例,女性3例;年龄1～14岁,平均年龄6.3岁;体质量8～71 kg,平均体质量25.8 kg,10 kg以下仅3例。行41例次CBP治疗,重点观察治疗中不同儿童死亡风险(PRISMⅡ)评分、不同体质量、不同临床干预(血管活性药使用与否、机械通气有无、不同超滤率)患儿死亡率和血流动力学变化。结果PRISMⅡ评分>10分、有机械通气患儿的死亡率比PRISMⅡ评分≤10分、无机械通气患儿高(P<0.05)。体质量>26 kg组死亡率、低血压发生率与体质量≤26 kg组相比,差异无统计学意义(P>0.05),但体质量低于26 kg组平均动脉压(MAP)、平均心率(HR)、升压药使用频率显著高于体质量>26 kg组(P<0.05)。超滤率大于/小于2 mL/(kg.h)两组MAP、HR、升压药使用频率差异无统计学意义(P>0.05)。结论体质量8 kg以上儿童运用预充量52 mL滤器行CBP治疗只要预充得当,合理范围超滤率下可以避免严重血流动力学波动,安全救助患儿;需要CBP治疗的多脏器功能不全综合征(MODS)患儿死亡率在PRISMⅡ评分>10分、有机械通气、使用血管活性药物者较高。Objective To investigate the effect of continuous blood purification（CBP） therapy on acute renal injury（AR1） and ARI combined with multiple organ failure（MOD10. Methods A total of 17 children with ARI and MODS from 1999 to 2010 were enrolled, male 14, female 3, aged 14 years old, mean age 6.3 years old; body weight 8 - 71 kg, mean body weight 25.8 kg, 3 casesbelow 10 kg. After treatment with CBP, the pediatric risk of mortality（PRISM Ⅱ） score was evaluated, and the effects of weight and different clinical interventions （vasoactive drugs treatment, mechanical ventilation and changing uhrafiltration rate） on mortality and hemodynamic chang were observed. Results The mortality rate of children with mechanical ventilation, and PRISM Ⅱ 〉 10was higer than that of without mechanical ventilation, and PRISM 11 ≤ 10,The mortality rate and incidence of low blood pressure between body weight over and under 26 kg was not significantly different（P 〉 0.05）. However the mean arterial pressure（MAP）, mean heart rate（HR）, and frequency of using vasoactice drug in weight under 26 kg group were significant higher than weight over 260000000 kg（P 〈0.05）. The difference of MAP, HR, and frequency ofvesoactive drug between ultrafiltration（UF） rate over or under 2 mIJ（kg, h） were not significant difference（P 〉 0.05）. Conclusion It is demonstrated the CBP could be safely applied to the children with body weight over 8 kg by 52 mL, a reasonable UF rate for avoiding serious hemodynamic fluctuations. The mortality rate is higher in CBP children with MODS ,PRISM Ⅱ 〉 10, and using mechanical ventilation and vasoactive drugs.

关 键 词：儿童 急性肾衰竭 多脏器功能不全 连续性血液净化 

分 类 号：R726.9[医药卫生—儿科]